Description:

Removal of sperm from the testicle can be accomplished by needle aspiration or by surgical means. Surgical removal of sperm from the epididymis (the site of temporary sperm storage) or directly from testicular tissue is more commonly practiced than needle aspiration since it results in greater quantity of sperm, some of which can be stored for future procedures. Under magnification, after making a small incision in the testicle under local anesthesia, the sperm can be removed from the epididymis (microsurgical epididymal sperm aspiration, MESA) or from the testicle itself (testicular sperm extraction, TESE). Testicular sperm aspiration (TESA), while less invasive, results in less sperm and is infrequently practiced today.

Indications:

Failure of vasectomy reversal or contraindications to reversal (i.e. vasectomy performed more than 5-10 years ago) are the most common indications to MESA or TESE. In situations where there is no sperm on the semen analysis without known blockage, surgical sperm removal may be attempted as well. In cases of inability to ejaculate (such as in spinal cord injury), surgical extraction of sperm is a viable alternative.

Contraindications, complications, adverse effects:

As with any surgical procedure, bleeding, infection, injury, or anesthesia risks are possible. In sperm extraction procedures, however, these complications are rare. Local pain and swelling usually last less than one week. Scarring of the testicle and atrophy (shrinkage) are very uncommon. The procedure should not be performed if the male has certain genetic disorders that are likely to be transmitted as life-threatening disorders to the offspring.